Microembolic signals and intraoperative stroke in carotid endarterectomy

Cerebral microemboli detection and differentiation during transcatheter closure of atrial septal defect in a paediatric population

“…Whereas several authors have not found a link between embolic signals and new onset symptoms of cerebrovascular disease, [38][39][40] other studies have demonstrated an association. [41][42][43] The findings of one of these studies suggest that both solid and gaseous emboli may be harmful to the brain, 41 a finding that is supported by other authors. 44,45 Of all the cerebral microembolic signals detected, 84.4% were detected during either balloon sizing or device placement.…”

Transcranial Doppler Monitoring in Carotid Endarterectomy: A Systematic Review and Meta‐analysis

“…The total sample size consisted of 4705 patients who underwent transcranial Doppler monitoring of either MCAV or MES (Table ) . The mean age of the patient population was 66.09 years.…”

“…Combining these modalities can also provide insight into simultaneous hypoperfusion and embolization. To create an ideal intraoperative monitoring standard that can substantially reduce perioperative morbidity and mortality, we need a method that can detect all potential cerebrovascular insults that can lead to stroke …”

“…To create an ideal intraoperative monitoring standard that can substantially reduce perioperative morbidity and mortality, we need a method that can detect all potential cerebrovascular insults that can lead to stroke. 8,15,36 Although transcranial Doppler monitoring is not a standard intraoperative neuromonitoring modality during interventional neurovascular procedures compared to the extensively studied and widely preferred alternatives such as SSEPs and EEG, further studies on simultaneous MCAV and MES changes could help validate transcranial Doppler sonography as the primary modality to detect and predict perioperative strokes. As such, transcranial Doppler changes can alert the surgeon for the need to incorporate cerebral protection measures during CEA such shunting to reverse hypoperfusion, adapt their technique for careful dissection of the vessels, and allow for back bleeding and flushing to avoid embolization after flow restoration.…”

Operative Factors Associated with the Development of New Brain Lesions During Awake Carotid Endarterectomy

“…9,11,12 DWI is a more accurate method than clinical examination to assess the brain for ischaemic change especially in asymptomatic patients. 13,14 Flow reduction during clamping could also cause DWI-detected ischaemia and this may be most relevant in patients who are shunt dependent and likely to have little cerebral reserve during the clamp time required for shunt insertion and removal. By documenting new DWI ischaemia using previously published CEA methods, 15 procedural variables having statistically significant influences on the cerebral findings could also be demonstrated.…”